Please save this Registration Form as a file, edit it, 
and e-mail your completed form to our Database Manager:
Jeff Ford K0JEF:  jmjford@verinet.com
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                 Amateur Radio Emergency Services
                          District 10
                 (Larimer-Weld-Jackson Counties)
                        Registration Form


Name:
Callsign:
Class of Amateur Radio License:
Street Address:
City:
ZIP:

Home Phone:
Work Phone:
Cellular Phone:
Pager:
Email Addresses:

Mailing Address if different:


Equipment Capability (please briefly describe):

HF Bands?:
  Portable:
  Mobile:
  Home/Base:

VHF Bands?:
  Portable:
  Mobile:
  Home/Base:

UHF Bands?:
  Portable:
  Mobile:
  Home/Base:

Emergency Power?:
  Batteries:
  Generator:
  Other:

Portable Antennas:
Do you have a Drivers License?:
4 Wheel Drive?:

Current Red Cross Training:


Any experience which you may have in Emergency Communications:


Any Special Training, Skills, or Life's Experiences which you feel
may be beneficial to ARES:

Days and Times which you are definitely _Not_ Available:

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This http://home.earthlink.net/~aresco10/index.htm page was last changed
Sep 30 2001.